a way of treatment of splintered fractures of a calcaneus (the demand for the invention № 2003133047/20 (035390), a priority from 17.11.2003).

The essence of an offered way consists that through forward otyodel a calcaneus two crossing spokes spend, one of them in nayopravlenii from back to a sole from the inside under an angle 30 ° to a horizontal plane, another from the inside in a direction from poyodoshvy to back under an angle 35 ° to shrizon galnoj planes and 65 ° to the first spoke which fix on the arc leg bridged by means of the face carving terminations with possibility of axial movings with base koltseyovoj by a leg of the apparatus, the bottom third of diaphyses located at level bertsoyovyh bones and fixed to the last by means of two crossing spokes, one of which passes through both bones of an anticnemion, and another only through big bertsovuju a bone in parallel its internal grayoni, through a hillock of a calcaneus from shift spend a spoke with an emphasis in a horizontal plane of perpendicularly long axis of a calcaneus, Which extremities fix on arms in sharnirno established P - the figurative leg having possibility of axial and angle moving poyosredstvom of carving hinges concerning an arc leg, and, after ustraneyonija all kinds of shifts, carry out stabilisation.

Carrying out of two crossing spokes through forward department pjatochyonoj bones, from the inside, one of which settles down under an angle 30 °, another - 35 ° to a horizontal plane provides stable bracing and possibility of restoration of a crest of foot, considerably reduces probability of damage by spokes of neurovascular fascicles of foot, muscles and tendons.

At such way of carrying out the first spoke in a point vkola passes intermeal a tendon of a back tibial muscle and a muscle tendon dlinnoyogo sgibatelja fingers, further through joint a process and forward department of a forehead

Calcaneus also leaves between tendons long and short malobertsoyovoj muscles.

The second spoke vkola passes in a point between a taking away muscle of I finger and a muscular part short sgibatelja foot fingers, settling down it meyozhdu internal and external plantar neurovascular fascicles on sufficient distance from them, further passes through forward department of a calcaneus and leaves outside, passing the important anatomic formations.

Bond of an arc leg by means of the face carving terminations of laths with possibility of axial movings with a base ring leg apyoparata provides the dosed out decompression podtarannogo a joint.

Bracing by a base ring leg of the apparatus to the bottom third of diaphyses bertsovyh bones by means of two crossing spokes, one of which passes through both bones of an anticnemion, and another only through big bertsovuju a bone in parallel its internal side, warns her zaprokidyvanie at bringing down of a hillock of a calcaneus and allows to overcome draught a purse ikroyonozhnoj a muscle causing shift of a hillock of a calcaneus in a cranial direction.

Carrying out of a spoke with an emphasis through a hillock of a calcaneus from the party smeyoshchenija in a horizontal plane of perpendicularly long axis of a calcaneus allows to put to a calcaneal hillock of force, the return to action ikroyonozhnoj and plantar muscles (equally effective these forces corresponds to an axis of a normal calcaneus) that facilitates a reposition, elimination valyusnoj or varus deformation of a calcaneus and provides stable fiksayotsiju fracture.

Bracing of a spoke with an emphasis, the calcaneus spent through a hillock on arms in sharnirno to the established 11-shaped leg having vozmozhyonost axial and angle movings by means of carving hinges otnoyositelno of an arc leg provides restoration of normal length of a calcaneus and frames conditions for a definitive reposition and adaptation on a fracture plane, allows to carry out

Fig. 10.

The dosed out compression-distraction of fragments of a calcaneus in the course of treatment. Configuration of the apparatus of external bracing is presented on fig. 10.

Way carry out as follows: a base ring leg 1 have at level of the bottom third of anticnemion, to a leg 1 two pereyokreshchivajushchiesja fix spokes 2 and 3, one of which 2 spend through both bertsovye bones, and another 3 - through big bertsovuju a bone in parallel its internal side. To a base ring leg 1 mount the arc leg 4 consisting of a half ring 5 and laths 6 with face carving terminations.

Two crossing spokes 7 and 8 through forward department pjayotochnoj spend bones in position of an easy plantar flexion of foot (to an angle 100 - 110 °) and fix them on an arc leg 4. The scheme of carrying out of spokes through peredyony calcaneus department is presented on fig. 12.

Fig. 12. The scheme of carrying out of spokes through forward department of a calcaneus.

In junctions of a half ring 5 with laths 6 mount odnoploskoyostnye axial hinges 9 of two arms bridged among themselves. To axial hinges krepjat carving hinges 10 by means of which with dugoyovoj a leg 4 bridge the P-shaped leg 11 consisting of a lath of 12 and two arms 13.

Through a hillock of a calcaneus from shift in a horizontal plane of perpendicularly long axis of a calcaneus spend a spoke with an emphasis 14 and fix it to arms 13 P-shaped legs 11. posredstyovom a carving hinge 15 with the two-axial hinge 16 bridge the P-shaped leg 11 to a lath 17 mounted on a base ring leg 1 in its back part.

For a reposition of fragments of a calcaneus carry out a distraction on carving hinges 10. Vnu trennee or an external curvature calcaneal kosyoti (under the axial roentgenogram) eliminate by a distraction on a hinge 10 from deformation and a compression on kontralateralnomu to a hinge 10.

After "reklinatsii" the driven fragments of a calcaneus, posredstyovom distractions on a carving hinge 15, reduce a calcaneal hillock to neobyohodimogo level with a reconstruction u§la Bellera then carry out the dosed out compression of fragments of a calcaneus by means of carving hinges 10. By a distraction on the face carving terminations of laths 6 arched legs make the dosed out decompression podtarannogo and talocrural joints.

By means of a compression on the face carving termination of one of laths 6 and distractions but to corresponding termination kontralateralnoj laths 6, correction of rotatory shift of fragments of a calcaneus is possible.

After end of all stages of a reposition of a calcaneus carry out stabilisation of the apparatus by means of a tightening of nuts on carving hinges 10 and 15 and face carving terminations of laths 6.

With use of the given way chrezkostnyj an osteosynthesis osushchestvyolen to 18 patients of II investigated group (20 calcaneuses).

4.3.2.